Choi Hayoung, Cho Jong Ho, Kim Hong Kwan, Choi Yong Soo, Kim Jhingook, Zo Jae Ill, Shim Young Mog, Jeon Kyeongman
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea.
J Thorac Dis. 2019 Jan;11(1):200-205. doi: 10.21037/jtd.2018.12.102.
Although acute lung injury (ALI) that develops after esophagectomy is associated with significant morbidity and mortality, there is limited information on its overall clinical course. The objective of this study was to investigate the prevalence and clinical course of ALI after esophagectomy.
Data were collected from all consecutive patients diagnosed with ALI after esophagectomy for esophageal cancer from January 2012 through March 2017 and retrospectively analyzed.
During the study period, a total of 1,132 patients underwent esophagectomy for esophageal cancer and 52 (4.6%) patients developed postoperative ALI. At the time of ALI diagnosis, the median lung injury score of all patients was 1.8 (1.0-2.0). Among the patients with ALI, 17 (33%) patients required mechanical ventilation (MV) support, of which two failed to wean from MV and 15 were weaned from MV. The median MV duration was 4 days (interquartile range, 3-8 days). Corticosteroids were used in 33 (63%) patients. During corticosteroid treatment, superimposed infections were observed in 10 (30%) patients and surgical site complications were observed in 9 (27%). Overall in-hospital mortality was 10%.
The prevalence and mortality of ALI following esophagectomy in our study were lower than those of previous reports. However, the use of corticosteroids in patients with ALI following esophagectomy requires attention to the occurrence of surgical site complications and close surveillance to identify new infections.
尽管食管癌切除术后发生的急性肺损伤（ALI）与显著的发病率和死亡率相关，但其整体临床病程的相关信息有限。本研究的目的是调查食管癌切除术后ALI的发生率及临床病程。
收集2012年1月至2017年3月期间所有因食管癌行食管切除术后被诊断为ALI的连续患者的数据，并进行回顾性分析。
在研究期间，共有1132例患者因食管癌接受了食管切除术，52例（4.6%）患者发生了术后ALI。在ALI诊断时，所有患者的中位肺损伤评分为1.8（1.0 - 2.0）。在ALI患者中，17例（33%）患者需要机械通气（MV）支持，其中2例未能脱机，15例成功脱机。MV的中位持续时间为4天（四分位间距，3 - 8天）。33例（63%）患者使用了皮质类固醇。在皮质类固醇治疗期间，10例（30%）患者出现了叠加感染，9例（27%）患者出现了手术部位并发症。总体住院死亡率为10%。
我们研究中食管癌切除术后ALI的发生率和死亡率低于既往报道。然而，食管癌切除术后ALI患者使用皮质类固醇时需要注意手术部位并发症的发生，并密切监测以发现新的感染。
